Should women still take estrogen?

DEAR DR. ROACH: I have a question concerning estradiol. My gynecologist has me taking 1 milligram of estradiol daily. My internist recommends that I not take it. Which recommendation should I follow? I have never had hot flashes, so that is not a problem. My internist says that I need to gradually stop taking the estradiol. He says that this medicine has more problems than benefits.

It is hard to choose what to do. What do you recommend? – H.L.

ANSWER: Back in the 1990s, we often recommended that women take estrogen in order to prevent problems, in addition to treating hot flashes. Two important studies came out showing that estrogen appeared to cause problems as well as prevent them. The definitive answer as to whether estrogen causes more problems than it prevents still isn’t known, and it probably depends on many factors. The term “estrogen” as I am using it refers to a group of related compounds.

Estradiol is sometimes referred to as “bioidentical,” since it is the same hormone that a woman’s body makes, as opposed to conjugated equine estrogen (Premarin), which was most commonly used in the 1990s and earlier. The type of estrogen may make a difference in terms of risk. Also, estrogen is seldom given without a progesterone compound in women who have not had their uterus removed, and the type of progesterone appears to make a major difference in risk.

Briefly, the evidence suggests that estrogen reduces the risk of colon cancer and of osteoporosis and fractures. However, it increases the risk of blood clots. The largest areas of confusion are in breast cancer and heart disease. For conjugated estrogens with medroxyprogesterone, which has the best information, for 1,000 women in 10 years there were seven more heart attacks, eight more strokes, eight more blood clots in the lungs and eight more invasive breast cancers, but six fewer colon cancers and five fewer hip fractures.

Recent data suggest that women who start estrogen immediately at menopause have a lower risk of heart disease than those who start five or 10 years after menopause (in fact, they may have an overall lower risk, compared with women who don’t take estrogen). Women who took estrogen alone did not have an increased risk of breast cancer.

Because of the known harms of estrogen, at this time neither I nor any expert body recommend taking estrogen just to prevent problems. Until new studies become available, since you have no hot flashes, I agree with your internist.

DEAR DR. ROACH: I wanted to tell you of the unbelievable relief I’ve gotten from the small, very painful cracks that used to develop at the ends of my fingers next to the nails, usually in the winter. Since I started taking 1,000 mg of fish oil once a day, I have had only one crack. – R.L.S.

ANSWER: I couldn’t find any studies on this, but anecdotal reports say fish oil may be helpful and is unlikely to harm. It’s reasonable to give it a try. I would recommend a supplement that contains both EPA and DHA. The Costco brand was found to be of high quality.

Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.